Evaluation Of The Distribution Of Candida Species In The Blood Culture Of Icu Patients

Year 2022, , 99 - 104, 30.12.2022

Fatma Günbey , Zülal Aşcı Toraman , Merve Ayyıldız Arslan , Doğukan Faik Baytaş , Yasemin Bulut Feray Ferda Şenol , Yüksel Akkaya

https://doi.org/10.30708/mantar.1191002

Abstract

Candidemia is an infectious disease caused by yeast fungi of the Candida (C.) species. It is one of the important bloodstream infections with high mortality and difficult to early diagnosis and treatment, mostly occurring in the intensive care units of hospitals. The incidence of candidemia-causing species can vary from country to country and even between hospitals in the same country. Candida albicans (C. albicans) is the most common cause of candidemia. However, in recent years, the incidence of candidemia due to non-albicans Candida species has increased. In this study, the distribution of Candida species detected in blood samples sent from patients with suspected candidemia from intensive care units to the Microbiology laboratory of Fırat University Faculty of Medicine between July 2017 and July 2022 was conducted retrospectively. The blood culture bottles delivered to our laboratory were placed in the BD BACTEC™ blood culture device. Gram positive fungal spores were searched in Gram staining done directly from blood culture bottles that gave a positive signal after 24 hours. Passages of 5% sheep blood agar medium (Oxoid, UK), eosin-methylene blue (EMB, Oxoid, UK) and Sabouraud Dekrose Agar (SDA, Oxoid, UK) were made from positive bottles. The cultures were evaluated for their growth at the end of their incubation at 35-37°C for 18-24 hours bacteriologically and 18-72 hours (sometimes 1 week) mycologically. Identification of microorganisms; Colony structures were performed based on Gram stain, germ tube test, conventional biochemical test results and matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) technique C.albicans species were detected in 208 (38%) and non-albicans Candida species in 335 (62%) of 543 blood cultures positive for Candida spp. Among non-albicans species, C. parapsilosis was most frequently isolated in 174 (32%) samples.
C.albicans is still the most frequently isolated species from candidemia cases. However, non-albicans species continue to cause blood infections with increasing frequency in intensive care patients.

Keywords

Candida albicans, MALDI-TOF MS, Candida, Sabouraud Dektroz Agar

Yoğun Bakım Hastalarının Kan Kültüründe Üreyen Candida Türlerinin Dağılımının Değerlendirilmesi

Abstract

Kandidemi, Candida (C.) türü maya mantarları tarafından oluşturulan bir enfeksiyon hastalığıdır. Çoğunlukla hastanelerin yoğun bakım ünitelerinde ortaya çıkan erken tanısı ve tedavisi zor, mortalitesi yüksek önemli kan dolaşımı enfeksiyonlarındandır. Kandidemiye neden olan türlerin insidansı ülkeden ülkeye, hatta aynı ülkedeki hastaneler arasında değişebilmektedir. Kandidemi etkeni en sık Candida albicans (C. albicans)’dır. Ancak son yıllarda non-albicans Candida türleri ile gelişen kandidemi insidansında artış görülmeye başlanmıştır. Bu çalışmada Temmuz 2017- Temmuz 2022 tarihleri arasında Fırat Üniversitesi Tıp Fakültesi Mikrobiyoloji laboratuvarına yoğun bakım ünitelerinden kandidemi şüpheli hastalardan gönderilen kan örneklerinde saptanan Candida türlerinin dağılımı retrospektif olarak yapılmıştır. Laboratuvarımıza gelen kan kültür şişeleri BD BACTEC™ kan kültürü cihazına yerleştirilmiştir. 24 saat sonra pozitif sinyal veren kan kültür şişelerinden direk yapılan Gram boyamada Gram pozitif mantar sporları aranmıştır. Pozitif şişelerden %5 koyun kanlı agar besiyeri (Oxoid, İngiltere), eozin-metilen blue (EMB, Oxoid, İngiltere) ve Sabouraud Dektroz Agar (SDA, Oxoid, İngiltere) pasajları yapılmıştır. Kültürler bakteriyolojik olarak 18-24 saatlik, mikolojik olarak da 18-72 (bazen 1 hafta) saatlik 35-37°C’lik etüvdeki inkübasyonları sonunda üremeleri yönünden değerlendirilmiştir. Mikroorganizmaların tanımlanması; koloni yapıları, Gram boyama, germ tüp testi, konvansiyonel biyokimyasal test sonuçları ve matris destekli lazer desorpsiyon/iyonizasyon uçuş süresi kütle spektrometresi (MALDI-TOF MS) tekniğine dayalı olarak gerçekleştirilmiştir. Candida spp.yönünden pozitif 543 kan kültürünün 208’inde (%38) C. albicans, 335 (%62) ’inde non-albicans Candida türleri saptanmıştır. Non-albicans türlerden ise en sık 174 (%32) örnekte C. parapsilosis izole edilmişitir.
Kandidemi olgularından halen en sık izole edilen tür C. albicans’tır. Ancak yoğun bakım hastalarında non-albicans türleri de artan sıklıkla kan enfeksiyonlarına yol açmaya devam etmektedir.

Keywords

Candida, Candida.albicans, Sabouraud Dektroz Agar, MALDI-TOF MS., Candida albicans, MALDI-TOF MS

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